Ryan’s voice breaks mid-sentence, turning the end of the word “planning” into a strangely plaintive husky whimper. He coughs several times and then blows his nose. He is in a meeting with four others from the organisation, people who sympathize when he makes a small mistake and later, forgets to finish his thought. He sniffles several times, blows his nose again and coughs every few minutes. When the meeting is done, he shakes everyone’s hands and goes back to his desk.

Five days later, his most impactful contribution to the meeting is revealed when everyone present comes down with a cold.

David struggled through the weekend but was better by Monday, though he is out of pocket $140 for a concert he and his girlfriend were looking forward to but couldn’t attend. Ilona took three days off and started to feel better but then her 4-year-old got sick and couldn’t go to childcare, so she took another two days off to look after him. Shane doesn’t work enough hours to get sick leave so he continued to go to work, starting the cycle all over again.

This story plays out every day in my beloved country, where people are ignoring their bodies and showing up to work sick.

A big part of the problem is a lack of sick leave. Only 74% of full-time workers and 24% of part-time workers have access to sick leave at all; and many of those suffer with “use it or lose it” policies where entitlements are lost if they’re not used, and others like me have all their leave in one pot, meaning a day off for a cold means one less precious day on the beach in Cabo. For many workers, taking a sick day can mean they fail to make rent, or even risk losing their job. So if the virus isn’t actively killing you, it’s tempting to throw back those cold and flu meds and soldier on.

And then there is healthcare. The oft-quoted statistic is that more than 10% of Americans have no healthcare; which is horrifying in itself. But when you look at people of working age – 18 to 64-year-olds – the number of uninsured climbs to 16%, or about 31 million people. That’s a lot of infected Shanes sneezing in a lot of open-plan offices.

And it gets considerably more gross, as the National Partnership for Women & Families’ Steffany Stern told the Pennsylvania House in 2008:

Workers in direct contact with the public every day are the least likely to have paid sick days. Seventy-eight percent of food and public accommodation workers have no paid sick days, and most workers in child care centers, retail, and nursing homes also lack paid sick days. Nobody wants a sick worker sneezing in their food, passing illness at the store, or infecting children and seniors. We want sick children to recover at home and not infect other children at school or in day care. We are all at risk when workers cannot stay home when they are sick or need to care for a sick child or family member.

But healthcare and sick leave access are only part of the puzzle. In the case of our virus-shedding handshake protagonist, Ryan, he’s one of the lucky ones, with sick leave benefits and top-notch healthcare, both paid by the company as part of his executive-level package. So why did he go to work, and why oh why did he go to that meeting when his sole contribution was half a sentence and the gift of several miserable days for everyone there?

Well, it turns out there is a cultural phenomenon at work. It’s called presenteeism, the word a cute nod to its maligned cousin absenteeism, and research is just starting to demonstrate how much it costs the country.

Of course, this is not a uniquely American phenomenon. In my native Australia, there is also an attitude of toughen up and get through the day. In newsrooms, coming in with a stonking hangover would, in fact, get you respect and cheer – even if you were running off for a quick chunder between editions. But if you showed up to work coughing and spluttering, it’s also likely that someone would tell you that your germs were not welcome and you should get your ass home.

In unfalteringly polite America, that doesn’t seem appropriate. And Ryan was probably just doing what he thought was expected of him. But Ilona is now down five days of her sick time for the year and Ryan’s cold is just getting worse. Now, Trent from accounting is going home sick. Still, no one is saying a word…